Grace Calvani/MBLatin Chamber
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City of Miami Beach Office of the City Clerk
1700 Convention Center Drive, Miami Beach, FL 33139
LOBBYIST REGISTRATION FORM
Lobbyist means all persons employed or retained, whether paid or not, by a principal who seeks to encourage the passage, defeat
or modification of any ordinance, resolution, action or decision of any commissioner; any action, decision, recommendation of the
City Manager or any city board or committee; or any action, decision or recommendation of any city personnel defined in any
manner in this section, during the time period of the entire decision-making process on such action, decision or recommendation
that foreseeably will be heard or reviewed by the city commission, or a city board or committee. The term specifically includes the
principal as well as any employee engaged in lobbying activities. The term "Lobbyists" has specific exdusions. Please refer
to Ordinance 2004-3435.
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NAME OF LOBBYIST:
J.1 (0,.,,/ ?Jt'/il'1
BUSINESS NAME AND ADDRESS
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(Last) (First) (M.!)
LM1'() chamber Dr Cofl1rnerce.- FlA. ~3139
(Number and Street) (City) (State) (Zip Code)
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EMAIL:
I. LOBBYIST RETAINED BY:
NAME1/;iRI~~:::'J~UE&eaclt- La.f1n chCdntp,-- 0 -f Cornlherce
5fO t;(}W{fl ~()OJ. - mt'm-1./ ~ead1 PIA. ~~J~'7
BUSINESS NAME AND ADDRESS (Number and Street) (City) J (State) (Zip Code)
C:!;OS) rn 1'-1,- ('fIll- (JDr) G'7 <I ~ 9DS;)-
TELEPHONE NUMBER: FAX NUMBER: (Optional) EMAIL: (Optional)
Fill out this section if principal is a Corporation, Partnership or Trust [Section 2-482 (c))
. NAME OF CHIEF OFACER, PARTNER, OR BENEACIARY: G ra.ce CalU:Zi1 i, PI"CSidellt
. IDENTIFY ALL PERSONS HOLDING, DIRECTLY OR INDIRECTLY, A 5% OR MORE OWNERSHIP INTEREST IN SUCH
CORPORATION, PARTNERSHIP OR TRUST: (IV / A )
SPECIFIC LOBBY ISSUE: V (, A 9 / /_
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Issue to be lobbied (Describe in detail): .
p~~~c1tV
II.
III. CITY AGENCIES/INDMDUALS TO BE, LOBBIED;
'. \
A) Full Name of Indlvidoal/TItle . " , B) Any Financial, Familial or Professional Relationship
.
.
(;CA Beard he Wlb.ers f1 one-
IV. DISCLOSURE OF TERMS AND AMOUNTS OF LOBBYIST COMPENSATION (DISCLOSE WHETHER HOURl Y,
FLA T RATE OR OTHER):
A) LOBBYIST DISCLOSURE: (Required)
sala n'ed ernp/~
B) PRINCIPAL'S DISCLOSURE (OF LOBBYIST COMPENSATION): (Required).
1) Pursuant to Ordinance No. 2003-3393 Amendina Miami Beach Citv Code Chaoter 2. Article VII. Division 5
Thereof Entitled "Camoaian Finance Reform" Via The Addition Of Code Section 2-488 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Procurement Issues":
2) Pursuant to Ordinance No. 2003-3395 Amendina Miami Beach Citv Code Chaoter 2. Article VII Division 5
thereof Entitled "Camoaian Finance Reform". Via The Addition Of Code Section 2-490 Entitled "Prohibited
Camoaian Contributions Bv Lobbvists On Real Estate Develooment Issues":
V. SIGNATURE UNDER OATH:
ON OCTOBER 1ST OF EACH YEAR, EACH LOBBYIST SHALL SUBMIT TO THE CITY CLERK A SIGNED
STATEMENT UNDER OATH, LISTING LOBBYING EXPENDITURES, AS WELL AS COMPENSATION
RECEIVED, IN THE CITY OF MIAMI BEACH FOR THE PRECEDING CALENDAR YEAR. A STATEMENT
SHALL BE FILED EVEN IF THERE HAVE BEEN NO EXPENDITURES OR COMPENSATION DURING THE
REPORTING PERIOD.
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Signature of Lobbyist (not- a... i b(f'S-J)
I do solemnly swear that all of the foregoing facts are true and correct and that I have read or am
familiar with the provisions contained in Section 2-482 of the Miami Beach City Code and all reporting
requirements. (J il _ .
Signature of Lobbyist: ~ ~
Signature of Principal/Client: fA, ilJ 1Yli I R01eh '-olin ~M~( cf c,m(}1CY<C',.
VI.
LOBBYIST IDENTIFICATION:
PRINCIPAL IDENTIFICATION:
[J Produced ID
lJ Produced ID
Form of Identification
~erSOnallY known (Lobbyist)
Form of Identification
~rSOnallY known (Principal)
(~~~~)
VII. SIGNATURE AND STAMP OF NOTARY:
State of Florida, County of Miami-Dade
Sworn 4,0 and subscribed before me if
Th'. :p j-A-- day of l.. 20P
~
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State of Florida, County of Miami-Dade
Sworn an(l,5ubscribed before me J
This~ay , 20 l) 7
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'lie
COMMIMION , DDOD6.56
IlCI'HIl!S Sl!P (1f 200S
IIONCeO HOUGH
AIlINoIfAGI! NON\'
C NTHIA M. LEE
COMMISSION' llO().(7656
EXNES Sf" 07 200S
&oNOm .fl'.:')tJGH
-~NOTArY
/. FOR CLERK'~E ONLY / I
Annual Registration fee: [ ] Yes (' ] No Amount Paid. MCR # t::::;/ /} Date Paid q.lr
Lobbyist Registration Form received and verified by: ~ k&- '1/.34ti4-
Revised 02/10/04 F: CLER\ALL\MARIA-M\LOBBYIST\LOBBYIST FORM 04